Training in Basic Life Support and Bystander-Performed Cardiopulmonary Resuscitation and Survival in Out-of-Hospital Cardiac Arrests in Denmark, 2005 to 2019

Abstract

ImportanceStrategies to improve survival from out-of-hospital cardiac arrest (OHCA) include mass education of laypersons with no official duty to respond to OHCA. In Denmark, basic life support (BLS) course attendance has been mandated by law in October 2006 for obtaining a driver’s license for all vehicles and in vocational education programs.ObjectivesTo examine the association between yearly BLS course participation rate and bystander cardiopulmonary resuscitation (CPR) and 30-day survival from OHCA and to examine if bystander CPR rate acted as a mediator on the association between mass education of laypersons in BLS and survival from OHCA.Design, Setting, and ParticipantsThis cohort study included outcomes for all OHCA incidents from the Danish Cardiac Arrest Register between 2005 and 2019. Data concerning BLS course participation were supplied by the major Danish BLS course providers.Main Outcomes and MeasuresThe main outcome was 30-day survival of patients who experienced OHCA. Logistic regression analysis was used to examine the association between BLS training rate, bystander CPR rate, and survival, and a bayesian mediation analysis was conducted to examine mediation.ResultsA total of 51 057 OHCA incidents and 2 717 933 course certificates were included. The study showed that the annual 30-day survival from OHCA increased by 14% (odds ratio [OR], 1.14; 95% CI, 1.10-1.18; P < .001) when BLS course participation rate increased by 5% in analysis adjusted for initial rhythm, automatic external defibrillator use, and mean age. An average mediated proportion of 0.39 (95% QBCI, 0.049-0.818; P = .01). In other words, the last result indicated that 39% of the association between mass educating laypersons in BLS and survival was mediated through an increased bystander CPR rate.Conclusions and RelevanceIn this cohort study of Danish BLS course participation and survival, a positive association was found between annual rate of mass education in BLS and 30-day survival from OHCA. The association of BLS course participation rate on 30-day survival was mediated by the bystander CPR rate; approximately 60% of the association of BLS course participation rate on 30-day survival was based on factors other than increased CPR rates.

Impact of sex of bystanders who perform cardiopulmonary resuscitation on return of spontaneous circulation in out-of-hospital cardiac arrest patients: A retrospective, observational study

“…These variables were selected based on previous literature suggesting an association of these factors with neurological outcomes. 16 , 17 …”

Implementation of basic life support education for the lay public in China: barriers, enablers, and possible solutions

“…Early community responses, including immediate recognition and activation of the emergency medical service (EMS) system, early cardiopulmonary resuscitation (CPR) and rapid defibrillation using an automated external defibrillator (AED), have the greatest impact on survival ( 3 ). Education for the lay public in basic life support (BLS) targeting community responses has shown great potential to increase bystander CPR rates and survival from OHCA ( 4–7 ), and has been emphasized by the formula for survival and international guidelines ( 2 , 8 , 9 ). In the recent years, the concept of “chainmail of survival” was proposed as a modern concept for adaptations of CPR systems.…”

“…The efficiency and effectiveness of BLS training can be influenced by factors at the national, regional, organizational, and individual levels. Strategies at the national or regional level, such as legislation, top-down buy-in, mandatory requirements for BLS training in schools and when acquiring a driver’s license, have been reported to improve BLS training ( 4 , 22 , 23 ). However, there has been limited exploration of organizational and individual factors and their influence on training implementation.…”

Comparison of the Four-step Basic Life Support Approach with Non-Standardised Training Approach in Achieving Basic Life Support Proficiency among the Healthcare Workers

“…2 The BLS course, designed by the American Heart Association (AHA), is widely accepted worldwide. 3 Traditionally, skills requiring repeated practice to gain proficiency relied on an apprenticeship model. Teaching and learning have evolved over the years, and student-based learning is becoming more widely accepted as the preferred method in medical teaching.…”

“…Teaching and learning have evolved over the years, and student-based learning is becoming more widely accepted as the preferred method in medical teaching. 3 There is also a move to standardise the teaching and assessment techniques to gain across-the-board acceptability for successful candidates and ensure safe health care for the patients. 4 Various models are used to ensure successful learning of practical skills, including the Knowledge, Skill and Simulation (KSS) model and Peyton's four-step approach, etc.…”